Suicide: A public health concern

Last week several of my clients and family members talked about Cafe Coffee Day founder VG Siddhartha's suicide and how it impacted them. Some of them reported feeling sad, anxious, unable to sleep; others were shocked, confused about his decision. Some clients reported how fears about their own debilitating mood conditions were triggered and others worried about their family members' mental health. If last week was emotionally hard for you, remember that you are not alone in this. Many others felt it too.

A suicide that's reported in the media or we hear of within our social circles immediately triggers our latent fears. It brings to the forefront the 'what ifs?' and feelings we have been trying to run away from. At the same time, it breaks our heart to think about the enormous grief that stands ahead of the family of the deceased.

As I heard my family, clients and friends talk about the death, I realised how everyone was trying to fathom the factors that contributed to it and in turn think what could have prevented it. The saddest part is we never really will have those answers. Those questions are our way of holding on to hope and a searching for personal meaning.

For around the first eight years of my career, I primarily did crisis and trauma work. All I understood was how every suicide played against a complex background of factors, some internal and some external to the individual. While suicide seems like this singular act, the context around it, the trauma that surrounded the person for years, and the failure of structural resilience is what gets missed out.

In my experience there are factors that increase the risk for suicide, such as depression, unemployment, financial troubles including poverty, legal, property-related matters, relationship concerns, and history of bullying, abuse and trauma. Factors such as race and class also add to vulnerability when it comes to suicide.

Other factors such as lack of social support, absence of community support, a history of alcohol and drug dependence, and family history of suicide exacerbate the risk for suicide.

From a gender perspective, both men and women seem to internalise their roles and eventually carry the expectations that come with it. Most men clearly associate the 'provider' role with their identity. Women on the other hand seem to measure their identity in ways where they are constantly in 'nurturing 'roles.

Overidentification with both these roles is problematic since people begin to associate shame and a sense of failure when they can't live up to these societal and self-imposed expectations.

"I have failed my family. I told my children I would always be there and take care of them in every way. I'm worried that my children would feel ashamed of me, since everyone is sooner or later going to talk about my debacle."

We worked around the client's suicidal ideation, impulses with a mix of therapy, medication and work with the family. What we consistently miss out on is how suicide prevention requires an approach where we build structural resilience and not just individual hardiness. While there are factors that can build an individual's resilience, that's just the beginning. The real solution lies in seeing suicide as a problem, which is a reflection of society's failure to create safety nets.

The structural resilience has to be a mix of macro policy level intervention along with powerful media representations that document the journey to recovery and most importantly building community narratives that allow for acceptance.

In the book 'Resilience: Why things bounce back', authors Andrew Zolli and AnnMarie Healy mention "Yet even the hardiest individual cannot do it alone - our resilience is rooted in that of the groups and communities in which we live in."

Maybe just as we need a village to raise a child, we also need an ecosystem of resilience at the community and social level too.

The next few articles would focus on building resilience in the context of individual and community lens.